硬膜外分娩镇痛对产程及分娩结局的影响

目的通过前瞻性的临床研究评价硬膜外分娩镇痛对产程及分娩结局的影响。方法选取2011年12月1~31日在本院产检
门诊正规产检并选择阴道试产的孕妇，临产后，无硬膜外镇痛禁忌证者，根据有无镇痛要求分别纳入镇痛组（166例），及对照组
（162例）。对比两组第1、2产程及总产程时间、出血量、分娩方式及新生儿结局等指标，探讨硬膜外镇痛对于产程和分娩结局的
影响。结果镇痛组第1产程（497.9±168.4）min、第2产程（54.3±43.8）min、总产程时间（522.1±178.9）min均显著高于对照组分
别为（404.2±156.0）min，（31.5±19.8）min，（435.8±159.2）min（P值均<0.05）；两组催产素使用率、中转剖宫产率、器械助产率、羊
水胎粪污染率、新生儿窒息的发生率均无统计学差异（P值均>0.05）。结论硬膜外镇痛会使产程延长，尤其是延长第2产程，但
不增加急诊剖宫产率和经阴道器械助产率，明显降低了社会因素手术率，对分娩结局无不良影响，用于分娩镇痛是安全的。

Effect of epidural analgesia on the duration of labor stages and delivery outcome

Objective To assess the effect of epidural analgesia on the duration of labor stages and the delivery outcome.Methods This prospective study was conducted in 328 nulliparous term parturients presenting for delivery in December 1 to 31,2011.The parturients were assigned into epidural analgesia group(n=162) and control group(n=166) according to their request when no contraindications were present.The stage I,stage II,and total duration of labor,volume blood loss,oxytocin use,delivery mode,and neonatal outcomes were compared between the two groups.Results In epidural analgesia group,the duration of stage I and stage II labor and the total duration of labor was 497.9±168.4 min,54.3±43.8 min,and 522.1±178.9 min,respectively,significantly longer than those in the control group(404.2 ± 156.0 min,31.5 ± 19.8 min,and 435.8 ± 159.2 min,respectively,P ≤ 0.05).No significant difference was found between the two groups in the rates of oxytocin use,emergency cesarean section,instrumental delivery,meconium-stained amniotic fluid,and low Apgar scores(P ≥ 0.05).Conclusion Epidural analgesia prolongs the labor duration,especially the second stage of labor,but it does not increase the incidences of emergency cesarean section or instrumental delivery or cause adverse effect on the neonatal outcome,and is therefore safe for pain relief in labor.